Arthrofibrosis of the knee is a complication of injury or surgery where an excessive scar tissue response leads to painful restriction of knee motion.
Page updated October 2023 by Dr Sheila Strover (Clinical Editor)
The normal knee has soft tissue folds that are lubricated and allow movement
Inflammation triggers sticky adhesions gluing up the tissue folds
Adhesions mature into scar tissue, which contracts and locks up the joint
The process of arthrofibrosis
The process is triggered by inflammation most commonly affecting the fat pad behind the patellar tendon. Then adhesions develop start to stick down the soft tissue folds of the suprapatellar pouch, posterior capsule and anterior interval underneath the tendon. This may result in flexion loss, extension loss or both. Matured scar tissue then contracts, closing the important spaces that normally allow movement, and pulling the kneecap right down (patella baja or infera), where every movement is painful.
Symptoms of early arthrofibrosis
Problems due to arthrofibrosis are uncommon but are usually consequent on significant knee surgery such as multiligament reconstruction or total knee replacement, or a bad knee injury where the joint has had to be immobilised, particularly where there may have been a bleed inside the knee (haemarthrosis), and painful swelling of the joint. The patient may have felt confident starting rehabilitation exercises but then may have experienced progressive problems bending the knee, and these early attempts may be excessively painful. 'Pushing through the pain' may simply make things much worse, triggering more inflammation and swelling, and further limiting range of motion. The joint may feel warm to the touch.
Symptoms of advanced arthrofibrosis and patella baja
As the soft tissues behind and below the kneecap become involved in the scar tissue process, the kneecap may be pulled into an abnormally low position (patella baja or patella infera) which may result in considerable pain trying to walk, and the knee may be most comfortable in a slightly bent position.
Rehabilitation issues with arthrofibrosis
Early range of motion problems can be reversed with empathetic management - ideally patellar mobilisation and range of motion exercises in combination with adequate pain relief - without pushing the joint into painful inflammation that makes things worse. Manipulation under anaesthesia may help to break adhesions before they become permanent scar tissue. Advanced arthrofibrosis with marked knee stiffness may need surgical lysis of adhesions to regain range of motion, in combination with specialist pain management and physiotherapy.
Quick links
Forum discussions
- Soft Tissue Healing Problems - Arthrofibrosis
Hundreds of patients' discussions about their experiences with arthrofibrosis.
- I want your arthrofibrosis success story please!!!
A long chat about members' experiences with knee arthrofibrosis.
- Compilation of Arthrofibrosis Success Stories Timelines
Several patients compare benchmarks for recovery from knee arthrofibrosis.
- "Arthrofibrosis Specialists"
Patients collecting names of specialists with an interest in arthrofibrosis.
Peer-reviewed papers
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Quote:
"...to date, there is still no consensus on the best surgical procedure and rehabilitation program following MLKI [multiligament knee injury] surgery to avoid AF."
Citation: Fahlbusch H, Krivec L, Müller S, Reiter A, Frosch KH, Krause M. Arthrofibrosis is a common but poorly defined complication in multiligament knee injuries: a systematic review. Arch Orthop Trauma Surg. 2023 Aug;143(8):5117-5132. doi: 10.1007/s00402-022-04730-9. Epub 2022 Dec 15. PMID: 36520199; PMCID: PMC10374851.
There is currently no content classified with this term.
Relevant content -
- Range of motion
- Continuous passive motion
- Patellar mobilisations
- Manipulation under anaesthesia
- Heel slides
- Active assisted flexion
- Insufflation
- Lysis of adhesions
- Anterior Interval arthrofibrosis
- Infrapatellar contracture syndrome
- Patella baja
- Capsulotomy
- Posterior capsulotomy
- Quadricepsplasty
2023 - Recommendations for the treatment of arthrofibrosis - by Dr Kayley Usher (Clinical Researcher)
2019 - All about arthrofibrosis of the knee - by Dr Sheila Strover (Clinical Editor)
2017 - Surgical Treatments for Established Arthrofibrosis: Salvage or Cure? - by Ms Michelle Boucher (Physician assistant)
2008 - Arthrofibrosis - course - by Dr Frank R Noyes (Knee Surgeon)
2007 - Arthrofibrosis Rehab Tutorials - by Dr Dirk Kokmeyer (Physiotherapist)
Peer-reviewed articles -
- 2011 - Outcome of surgical treatment of arthrofibrosis following ligament reconstruction - Authors: Said S et al. and summarised for you by Dr Sheila Strover (Clinical Editor)
- 2004 - Arthroscopic Treatment of the Arthrofibrotic Knee - Authors: Kim DH et al. and summarised by Dr Sheila Strover (Clinical Editor)
- 2003 - Rehabilitation of the arthrofibrotic knee - Authors: Millett PJ et al. and summarised for you by Dr Sheila Strover (Clinical Editor)
- 1999 - Joint debridement and soft tissue release as a salvage procedure for the severely arthrofibrotic knee - Authors: Millett PJ et al. and summarised for you by Dr Sheila Strover (Clinical Editor)
- 1982 - Arthroscopic treatment of postoperative knee fibroarthrosis - Authors: Sprague NF et al. published paper summarised by Dr Sheila Strover (Clinical Editor)
Arthrofibrosis library of excerpts
Udemy video-based course
The stiff knee after injury or surgery - how to manage it
by Dr Sheila Strover (Clinical Editor) and Mr Sebastiano Nutarelli (Physiotherapist)
eBook - Arthrofibrosis and patella baja
by Dr Sheila Strover (Clinical Editor)
eBook explaining how the patella can become intimately involved in the arthrofibrosis process. Free to download.